《保险研究》20240306-《挤入还是挤出：基本医疗卫生服务影响商业健康险消费效应分析》（邢晓卫、匡贤明）

［摘   要］基本医疗卫生服务与商业健康保险发展的关系对中国国民健康水平的提升和健康中国行动的实现具有重要意义。本文探讨基本医疗卫生服务对商业健康保险消费的影响。研究发现：商业健康保险消费具有时空依赖特征；基本医疗卫生服务与本地和周边地区的商业健康保险消费均存在U形关系；当基本医疗卫生服务达到特定阈值后，呈现本地和周边地区的双重“挤入”效应，但本地“挤入”效应更易实现；居民消费和风险意识是基本医疗卫生服务影响商业健康保险消费的重要中介变量，即基本医疗卫生服务通过改变居民消费和风险意识影响商业健康保险消费；基本医疗卫生服务影响商业健康保险消费的程度与方向，还受健康风险损失、互联网冲击、区域禀赋、健康保险供给主体和健康风险承载主体等因素影响。基于此，本文提出平衡资源配置、明确基本医疗卫生服务“基本”和“非基本”界限、关注居民个体行为和构建商业健康保险大生态系统等建议。

［关键词］基本医疗卫生服务；商业健康保险；挤入；挤出

［基金项目］国家自然科学基金项目“大数据情境下的国家级平台及金融信用创新应用研究”(92146005)；国家自然科学基金项目“半参数门限空间滞后模型理论研究及其应用”(72073030)。

［作者简介］邢晓卫，东北大学工商管理学院应用经济学博士研究生；匡贤明，东北大学工商管理学院研究员、博士生导师。

Crowding-in or Crowding-out: An Analysis of the Impact of Basic Medical and Health Services on Commercial Health Insurance Consumption

XING Xiao-wei ,KUANG Xian-ming

Abstract：The basic medical and health services and commercial health insurance are both for the improvement of the national health level and the realization of the Healthy China initiative.This paper attempts to explore the impact of basic medical and health services on commercial health insurance consumption.The study finds that: commercial health insurance consumption has the phenomenon of spatial and temporal dependence;there is a "U-shape" relationship between basic medical and health services and commercial health insurance consumption both locally and spatially.When the basic healthcare service reaches a specific threshold,it presents both local and spatial "crowding-in" effects,but the local "crowding-in effect" is easier to realize.Residents′ consumption and risk awareness constitute the mediator variables of the impact of basic medical and health services,indicating that basic medical and health services not only have an indirect impact through the impact of the two in the local area,but also has an spatial impact through the local residents′ risk awareness and consumption of the neighbouring residents,but the direction and extent of the effect are affected by the level of basic medical and health services.Affected by the differences in health risk losses,impact of the Internet,regional endowment,health insurance supply subject and health risk carrier subject differences,basic medical and health services in different time periods and samples will produce obvious heterogeneous impact.These lead to policy recommendations such as balancing resource allocation,clarifying the boundaries between "basic" and "non-basic" basic healthcare services,paying attention to residents′ individual behaviours,and building a large ecosystem of commercial health insurance.

Key words：basic medical and health services;commercial health insurance;crowding-in ;crowding-out